Stakeholder Advisory Group Minutes: February 2025

Attendees and apologies

Chairs
•    Neil Gray MSP, Cabinet Secretary for Health and Social Care
•    Caroline Lamb, Chief Executive NHS Scotland / DG Health and Social Care

Members in attendance
•    Alison Evison, NHS Board Chair Grampian
•    Andrew Moore, Representative of SEND
•    Andrew Elder, Royal College of Physicians of Edinburgh
•    Benjamin Hannan, Director of Reform and Transformation
•    Colin Poolman, Royal College of Nursing
•    Carole Wilkinson, Representative of NHS Board Chairs (Nationals)
•    Eddie Fraser, Representative SOLACE 
•    Eddie Follan, Representative COSLA
•    Emma Currer, The Royal College of Midwives Staffside
•    George Crooks, Digital Health and Care Innovation Centre
•    Hanny Eteiba, Royal College of Physicians and Surgeons of Glasgow
•    Heather Cameron, Chair of SDAHP / Director of Allied Health Professions
•    Issmael Fergague, Royal College of General Practitioners (Scotland)
•    Jann Gardner, Representative of NHS Chief Executive Group
•    James O’Connell, Representative Unite
•    John McAnaw, Representative of Directors of Pharmacy
•    John Robertson, Representative British Medical Association
•    Julie Mosgrove, Optometry Scotland
•    June Brown – Chair of SSND 
•    Karen Wilson, NHS NES
•    Katie MacGregor, Royal College of Occupational Therapists
•    Kirstin Dickson, Representative of NHS Directors of Planning
•    Lee Knifton, Mental Health Foundation
•    Matt Barclay, CEO, Community Pharmacy Scotland
•    Mark MacGregor, Representative of SAMD 
•    Margot McBride, Allied Health Professions Federation Scotland (AHPFS)
•    Matt McLaughlin, Representative Unison
•    Nick Fayers, Representative of Chief Officers Group
•    Pavan Srireddy, Royal College of Psychiatrists
•    Rachael King, Representative of Chairs and Vice Chairs Group - IJB
•    Sara Redmond, Alliance Scotland
•    Sharon Hilton-Christie, Representative of SAMD
•    Sharon Wiener-Ogilvie, Allied Health Professions Federation Scotland

Scottish Government officials:
•    Alistair Hodgson, Divisional Head, Strategy, Policy Corporate Services
•    Alan Gray, Director of Health and Social Care Finance
•    Amy Wilson, Deputy Director of Health Workforce Planning Development 
•    Anne Armstrong, Chief Nursing Officer 
•    Catherine Aglen, Pharmaceutical Advisor (Community Pharmacy)
•    Carolyn McDonald, Chief Allied Health Professions Officer
•    Christine McLaughlin, Co-Director of Population Health
•    Donna Bell, Director of Social Care and NCS Development
•    Douglas McLaren, Deputy Chief Operating Officer NHS Scotland
•    Fiona Hogg, Chief People Officer
•    Graham Ellis, Deputy Chief Medical Officer
•    Helen Moores-poole, Allied Health Professions Officer
•    Jennie Gollan, SG Special Adviser 
•    John Burns, Chief Operating Officer NHS Scotland
•    John Harden, Deputy National Clinical Director
•    Jonathan Cameron, Deputy Director, Digital Health and Care
•    Justine Craig, Chief Midwifery Officer
•    Kim Walker, National Programme Director
•    Lynne Taylor, Principal Psychology Advisor
•    Malcolm Summers, Head of Strategic Reform
•    Paula Speirs, Deputy Chief Operating Officer NHS Scotland
•    Philip Miller, Strategic Briefing and Insight Unit
•    Rachael McGruer, Deputy Director, National Care Service Local
•    Ria Phillips, Strategic Briefing and Insight Unit
•    Richard Foggo, Director of Population Health
•    Samantha Burns, Deputy Private Secretary
•    Tim Mcdonnell, Director Primary Care

Secretariat
•    Caitlin McLaughlin, Health Planning Team
•    Jo-Anne Swanson, Directorate Support Unit
•    Dawn Sungu, Directorate Support Unit 

Items and actions

Welcome and update on reform

The Cabinet Secretary for Health and Social Care welcomed members to the second Stakeholder Advisory Group (StAG). As part of the wide-ranging engagement with the sector, the Stakeholder Advisory Group is a key and ongoing part of that conversation. The Cabinet Secretary provided a reflection on some of the themes raised at the recent roundtable with health and social care stakeholders with the First Minister, which included:

• workforce planning
• planning for reform at a national level
• the need for a forum to consider and discuss the detail behind the plans
• shifting the balance of care and importance of continuity of care
• recognition of the role of 3rd sector

The Cabinet Secretary continued by highlighting the significant development in Scottish Government plans for reform and renewal. Importantly the proposed Scottish Budget which will deliver nearly £22 billion for health and social care.

The renewal plans primarily focus on four key areas:

• improving access to treatment
• shifting the balance of care
• improving access to health and social care services through digital and technological innovation, and prevention

These plans will look to firstly reduce the immediate pressures across the NHS. Progressing our plans to shift the balance of care from acute services to primary and community healthcare. Thirdly, this work will harness innovation – digital and technological – to improve access to care. An Operational Improvement Plan will be published in March, and a broader renewal plan will follow before summer recess in late June. The Population Health Framework, which will be published this Spring, will set out our actions to address that broader, long-term challenge, enabling people to live longer, healthier and more fulfilled lives.

In closing, the Cabinet Secretary affirmed the renewal and reform of our national services is vital, and a key aim of this Government. Therefore, co-operation and collaboration is at the heart of making this happen and engagement is a fundamental part of this process.

Update on NHS renewal

Douglas McLaren, Deputy Chief Operating Officer NHS Scotland, provided an overview of the products in the coming months that will add value. Underlining existing work, for example NHS boards’ annual delivery planning and building on investment proposed for 2025 / 2026, further detail on renewal plans were set out by the First Minister on 27 January and the accompanying detail provided to Parliament: 

These actions will be further detailed in the following suite of renewal and reform products published in the coming months, the aim being to add value to rather than displace processes already underway in the system

• an Operational Improvement Plan in March (which will expand on deliverables)
• Population Health Framework in Spring 
• longer term approach to health and social care service reform, to be published around early summer

The Operational Improvement Plan focusing on the next 12-18 months will cover:

• improving access (incl. improving waiting times and reducing delayed discharges)
• shifting the balance of care (incl. Hospital at Home, frailty and standardising good practice)
• digital and technological innovation
• prevention  

Comments from the wider group included: 

• whether the Operational Improvement Plan will also focus on the pressures in social care. It was noted that the SG will work with partners on this as there is a need for whole systems working and will build on the Collaborative Response and Assurance Group (CRAG) discussions on delayed discharge and how we work with whole systems and their partners
• there is a need to align the work force plan to support the Operational Improvement Plan. Also variation and consistency is an issue, what work has been done to share good practice  
• we need to be clear about the implications for the work force and to look at variation, what works best, bringing together best practice in order to provide a clear blueprint to boards and delivery partners, that is evidence based
• confirmation was provided to members that the programme for renewal extends to mental health and its workforce

NHS Renewal Themes

Improving Access to Treatment

John Burns, Chief Operating Officer NHS Scotland discussed that the Scottish Government is committed to reducing waiting times ensuring that by March 2026 no one is waiting longer than a year for their treatment, this will be done by: 

• increasing capacity: optimising National and Regional working, we will deliver over 150,000 extra appointments and procedures in 2025/26

• reducing the radiology backlog so that 95% of referrals are seen within six weeks by March 2026

• rolling out a new Digital Dermatology Pathway in all general practitioners across Scotland by Spring 2025

• expanding the Rapid Cancer Diagnostic Services: will continue to work with Health Boards to further expand these service pathways to ensure population coverage
• reducing the pressure in our hospitals - take action to free up capacity and reduce occupancy levels, including delayed discharges 
• clear Child and Adolescent Mental Health Services (CAMHS) backlogs and meet the 18-week target nationally by December 2025

Further discussion on the key elements from the First Minister’s speech:

• planned care – there needs to be a whole system approach and clarity on the actions we need to take as a system and the impact we want to make across Scotland. For example, set planning guidance at population level, i.e. protected planned care facilities 
• working collaboratively with NHS Board colleagues, we need to optimise and build on the expertise and resource we have. Medium and long term sustainability is needed in order to meet planned care targets
• there needs to be a focus on flow in the patient pathway – good effective discharge from hospital and the need to ensure we are delivering a consistent approach to care

Shifting the balance of care

• Tim McDonnell, Director of Primary Care discussed the First Minster’s speech had a three-stage approach to reform; the delivery plan, the population health framework and a longer term reform framework, these place a focus on primary and community care 
• immediate focus on measures to further enhance capacity in the community, draw on collective evidence based
• to enable concrete actions to shift the balance of care, this needs to be supported by delivery plans, critically with workforce and stakeholders
• measures are not exhaustive, relative bodies are being engaged with at all local systems and representative bodies
• hospital at Home and virtual beds increase to at least 2,000 by December 2026 - as well as expanding the type and coverage of treatments at home rather than in hospital
• frailty - direct access to specialist Frailty teams in every Emergency Department by summer 2025, i.e. directly by GP and Scottish Ambulance Service (SAS) to speciality frailty services rather than A&E and hospital 
• attempting to embed a new access quality framework to make access arrangements to GP services more consistent across Scotland and working closely with the SGPC to work out the contractual component through bilateral dialogue
• dental reform – targeted investment in the workforce to improve capacity and patient access in the short to medium-term and support payment reform
• deliver a new acute anterior eye condition service during 2025 and support the rollout of the Community Glaucoma Service to free up 40,000 hospital appointments per year. Working with Optometry Scotland to allow community eye care teams to see and treat patients in the community
• further discussed expanding the NHS Scotland Pharmacy First Service
• the conversation with the group noted that in respect shifting the balance of care, there is a need to consult broadly with those working and supporting in areas around general practice in order to move these services forward. Attendees noted that enhancements to public services within pharmacy, optometry and dentistry services, should be underpinned by fair work agreements
• in discussion it was noted that there was an intent to use this work to further shape the long term health and social care reform framework. Ongoing coordinated and collaborative reform engagement is critical to shifting the balance. Through the StAG and other groups i.e. the Primary and Community Health Steering Group as well as Mental Health and Wellbeing Strategy Leadership Board partnered developed work would be enabled and embedded

Digital and Technological innovation and prevention

• Jonathan Cameron, Deputy Director Digital Health and Social Care acknowledged the close partnership and engagement with those on the call today
• Jonathan further discussed the roll out of a new online app for health and social care: will bring forward delivery and begin to roll this out from December 2025, starting in NHS Lanarkshire 
• build on digital platforms to increase operating theatre capacity by June 2025. Will roll out a theatre scheduling tool that has been shown to increase productivity in operating theatres by up to 20%
• adopting new innovations - will start using genetic testing to deliver improved clinical outcomes and target medications, for recent stroke patients and newborn babies with bacterial infections 
• appointed care and diagnostics – will support 3,000 people newly diagnosed with type 2 diabetes over the next three years, with a new national digital intensive weight management programme
• working with partners on approaches for delivery. For example, unique identifiers i.e. rolling out CHI (Community Health Index) into local government, which will bring health and social care together through data
• maximising existing assets developed to date – Connect Me, Near Me, My Diabetes My Way, Digital Mental Health therapies and NHS inform
• delivering systems such as Theatre scheduling, Digital dermatology and Hospital at Home. Delivery of the new PACS system (Sectra) will look to improve access to digital images for radiology and research
• maximise advances in AI - enhancing core capability (importance of data strategy)

The conversation was opened to the group and the following points were discussed:

• there is a need for further conversations on the use of digital/AI - what it means for the way we provide services and for the people at the heart of these services – there is the need to develop a new technology agreement
• the collective challenges across the system were noted, including the need to minimise waste, investment in IT and digital and the impact of Brexit on recruitment of social care workers. There is a need for Health Boards to work together and learn from each other
• it was noted that consideration of the wrap around support (e.g. rehabilitation and prehabilitation) will be required to support the plans
• further conversations are required on community based self-management and discharge planning i.e. with carers’ organisations, to understand implications of the plans and the support required
• the cross sectoral approach to governance on digital work was noted as a good model and one which should be taken in other areas
• consideration is required on the impact of travel on patient care, the geographical issues and ensuring equality of access. Equality of digital connectivity also plays a role here
• on investment in digital systems and innovation, reassurance was requested that interconnectivity is being looked at. It was noted there are collective agreements with NHS on a “buy once” approach and noted the work currently with Microsoft 365 (easier to share information through this platform)
• on access to acute hospital care for elderly people, it was noted that some are admitted appropriately. Therefore, care should be taken to ensure that shifting the balance of care will not adversely impact on the older population
• the role of family and informal carers as part of the whole system was noted and the need ensure we have measures in place to evaluate this. The need to have plans beyond hospital at home to ensure longer term sustainability, partners in social care should be engaged on this
• the variation in the delivery of Hospital at Home was noted and the fact that some Boards are cutting community services, which may take Hospital at Home out completely, therefore need to consider this
• it was highlighted that the priorities set out by the First Minister have provided a renewed focus to decision making and the opening up of these discussions again was welcomed

Update on wider reform work

• Richard Foggo, Co – Director Population Health discussed Health and social care vision and the three products: Operational Delivery plan, Population Health framework (co-produced by COSLA, Directors of Population Health and Public Health Scotland) and the Longer term HSC service reform framework. 
• 80% of Scotland’s health and wellbeing comes from socio-economic factors and how people live their lives.  20% comes from HSC services. 
• Health and Social Care reform is crucial to achieve greater life expectancy, better health and wellbeing throughout the life course, and to ensure public services are sustainable and provide value for money.  Key is to bring service sustainability and population health together into coherent agenda.
• priorities in the prevention space (demand reduction) are tackling healthy weight and obesity.
• engagement – set out a framework over a 5-10 year period so initial feedback important but not the last chance.  We need to establish an inclusive culture of engagement, co-production.  
• in relation to the HSC service reform framework, the change must be embraced by everyone with clear direction. The five maxims that will guide our approach are: 

  • prevention first

  • people first
  • community first
  • digital first
  • planning for the population

Comments from the wider group included:

• to look at system levels and connection with society, high level strategic engagement (the importance of a community approach)
• need to focus on the impact of prevention interventions. Some interventions will not see any impact for 10 - 20 years, need to be realistic about the service impact of hospitals
• the importance of the role of secondary and tertiary prevention was highlighted. For example, a focus on rehabilitation now can yield a much quicker result whilst helping to advance primary prevention 
• Scotland has the possibility of doing prevention budgeting. Mental health and population health workstreams need to be aligned
• challenges with public health budgets, short and long term investments are needed to see a difference. For example, focussed spend on poverty issues can have a quick impact on quality of life
• a 3 horizon approach with equal investment in primary, secondary and tertiary prevention is required 

Next steps and closing remarks   

• Caroline Lamb thanked the group for the good discussion and made the following points:
• there is a need to now focus on the detail and delivery of the short, medium and long term approaches
• established channels should be used to support those detailed conversations but the SG was open to setting up new channels for stakeholders to have a space to discuss the detail underpinning these actions
• where stakeholders are in a position to implement service change, they should progress to do so

Date of next meeting

The next group meeting will take place Tuesday 18 March.